Family Nurse Practitioner Exam

Which clinical eye finding is NOT associated with chronic uncontrolled hypertension?

1. AV nicking

2. Copper wire arterioles

3. Flame-shaped hemorrhages

4. Microaneurysms

The correct answer is: Microaneurysms

Chronic uncontrolled hypertension leads to specific changes in the vasculature of the retina, which can be observed through various clinical findings. AV (arteriovenous) nicking occurs when the arterioles become so thickened that they compress the venules at points where they cross, a classic sign of longstanding hypertension. Copper wire arterioles refer to the appearance of narrowed, rigid arterioles that take on a coppery sheen, indicating chronic changes due to hypertension. Flame-shaped hemorrhages represent localized bleeding due to rupture of superficial retinal capillaries, which can also occur in the context of severe hypertension. These findings are all directly linked to the effects of uncontrolled high blood pressure on the retinal vascular system. Microaneurysms, however, are primarily associated with diabetic retinopathy. They occur due to changes in retinal capillaries from diabetes rather than hypertension. Therefore, the clinical eye finding that is not associated with chronic uncontrolled hypertension is indeed microaneurysms, as they reflect a different pathological process related to diabetes rather than to the hypertensive changes seen in the other findings.